<^ . r\ * . " o . 



-^ rP 



.\^ 






• .-t'^. .^^ 



A* 





■^o 


o^ . 








x^ 


•^^ ■ 






.^^ 




'^ 








s • 


■/* *^ 




^ 




-. 




^-:> 


.sX^' 








•<'\" 








, '^ 


•J' 








.-b' 


J-: 








A"' 


•>*, 










ri- 









0' o 



■V 



y^ ^0^ 









\->:^t.>* ^<.--«-^-/ V^^^'V \:--f}:--\c:^ 






/ ^ % \ <^-\ 



c-C-^V 



'b V 










^^•v 

V ^ 



^ 






V ^ ' • " , o .0 .. ' , , ■' :. -^ 



.0 O 

0^ c, " " " .' "o 
G - o 















.0- 



-^.^ ^^ 









<r. 



o V 






-X 



^' 









-.0 



^^ 



Lc-^T...,/-_ ^ 



'^O' 



-':^ 0^ 



/^ 



,4 o. 



'>. 



A 



.^" 



^ O. 






V '- % '^'^ 



-^, 



.,,^.^. 



-^ 



O N -■?) 



,V 









^oV'^ 



v^ 



^ c> - 






-t.^^ 



o 



o > 



A 






o « o ' -Q) 

V 



^^ :#im,':. •^.c'i 






^°-;^, 



-.,-" 



^ 



V 



•5' 






^^^ ^<^ 






.V 



^-0^ 






,0- 






40, 






^V 


















-t^o^ 



\^<:5r{Y,.<^''^ ^ 






■c;> y- 



-^y 



■V . 



'bV 



A 



^'^ ^^ 



4. O 









^" -v 















'^o 



O V 






%f>^ * o „ o 






G° 






^*^°o 



.' ^V 









-Jv- 






N-v >■- % 

o - . . , . 



V ^?> ^.• 












^ 






'V 



-^^iH 



-f 









A 



.4 q,. 



* ^^' 



.^' 



^ ,^ w;-V-..^^ ^ ^^ 






v"^ 



^^ 















UNIVERSITY OF CALIFORNIA PUBLICATIONS 

IN 

AMERICAN ARCHAEOLOGY AND ETHNOLOGY 

Vol. 13, No. 5, pp. 175-213, plates 38-44, 8 text figures May 15, 1920 



THE MEDICAL HISTORY OF ISHI 

BY 

> SAXTON T. POPE 



CONTENTS 

PAGE 

Introduction 175 

Sickness of November, 1911 - 176 

Sickness of September, 1912 177 

Characteristics of Ishi 178 

Ishi's medical beliefs - 179 

Sickness of May, 1913 - 182 

Ishi's personal habits - 182 

Ishi's disposition and mentality - 187 

Clinical history, May, 1914 190 

Sickness of December, 1914 193 

Ishi's final sickness, 1915-1916 198 

Post mortem examination - 209 

Conclusion 213 



INTRODUCTION 

Often the incidental records of human life are the most interesting 
and illuminating. The factors of health, hereditary predispositions, 
and psychic reactions are of greater directing influence in the affairs 
of men and the making of historic events than is ordinarily under- 
stood. 

It is not without anthropological value that the following brief 
notes are recorded concerning the personal idiosyncrasies, physical 
attributes, somatic disorders, and pathologic findings of Ishi, the last 
Yahi Indian. 

At the time of the capture of our informant, he was undoubtedly 
in a state of starvation. He was extremely emaciated and weak 
(plate 38). As has been described by Waterman,^ this capture took 
place at Oroville, August, 1911. 



1 Univ. Calif. Publ. Am. Arch. Ethn., xni, no. 2, p. 64, 1918. 



17G Universitii of California Publications in Am- Arch, and Ethn. [Vol. 13 

The pliotograph taken at tliat time shows how j?reat the privations 
must have been to produce such a stiite of physical attenuation.^ Ishi 
hiuLself hiter made the statement that lie was not sick but had no 
food. White men had taken liis bow and arrows; game wa-s scarce, 
and hi' Jiad no means of procurinj2: it. He had strayed from his usual 
trail, between Deer creek and Mount Lassen. Thr raili"oad on one 
side and a lai-jre river on the other kept him from making his way to 
the refuge of the hills. His fear of trains and automobiles seems to 
have been considerable in those days. 

Upon being eaptun'd, Ishi, according to his own aeeoiint, was 
handcutfed, confronted by guns and i)ist()ls, and intimidated to such 
an extent that lie vomited with fear. He was taken to the county 
jail where he was held several days before he was rescued by Water- 
man and Iransl'ei-i-ed to the University of California. During this 
time, he said he touched no food and drank almost no water, so great 
was his dread of the white man. His treatment in jail seems actually 
to have been kijidly enough, and he certainly aroused much more 
curiosity than brutality; but he was undoubtedly badly frightened. 

He was taken to the University of California IMuseum of Anthro- 
pology in San Francisco. Here he was made to undei-stand the 
friendly feeling of the white man, and he began to comprehend the 
scheme of civilization to which he had hitherto been a stranger. He 
was given food and clothing, and was taught the many inhibitive 
lessons of modern life. 



SICKNESS OF NOVEMBER, 1911 

On November 22, 1911, less than three months after his arrival, 
he was taken sick with a cold, or a respiratory infection, and was 
entered as a patient in the Universit}^ Hospital. The record of this 
illness is as follows : 

CLINICAL EECORD FROM THE FILES OF THE UNIVERSITY OF 
CALIFORNIA HOSPITAL, SAN FRANCISCO 

Nov. 22, ]9ll. Blood Examination. — Hemoglobin, 96%. Red corpuscles, 
4,516,000. White cells, 18,000. Polynudears, 85%. Large Mononuclears, 11%. 
Small Mononuclears, 4%. Eosinophiles, negative. Blood Cultures, negative. 
Blood smears, negative for plasmodia malaria. 

Nov. 23, 1911. Tuhercidin Keaction. — Calmette, negative; von Pirquet, nega- 
tive; Moro, negative. 

2 Ibid., plate 1. 



1920] Fope: The Medical History of Ishi 177 

Ui-iiiahjsis. — Yellow, clear. Specific gravity, 1022. Eeaction, acid. Sugar, 
5%. Albumen, negative. No pus. No diazo reaction. 

Nov. 25, 1911. Sputum Examination. — Small amount, tliin and watery; 
sputum streaked with bright red blood. No acid, fast bacilli, few gram positive 
diplococci. 

Stool Examination. — Liquid — brown — no occult blood; no parasites, eggs, or 
pus. 

Blood Pressure. — 125 mm. mercury. 

Dec. 26, i5ii.— Photograph taken of feet. Ishi has had temperature only 
once since he came in, and then only for a few hours. 

Jan. 24, 1912. — Since then he has had only moist nxles. Considerable thin 
frothy sputum — never hemorrhagic. 

Feb. 2, 1912. — He is discharged to-day with his cough cleared up though he 
has some expectoration. Diagnosis : Bronclio-pneumonia. 

Dr. Markel, 

Dr. I. W. Baldwin, 

Internes. 

During this illness the temperature chart shows that for the first 
week Ishi s fever ranged between 38° and 40° C. His pulse ranged 
between 60 and 105, his respiration between 18 and 35. It will be 
observed that his reactions to tuberculin at this time were negative. 
But the record at this early date indicates how susceptible he was to 
respiratory infections. 



SICKNESS OF SEPTEMBER, 1912 

On September 15, 1912, he was again entered as a patient in the 
University Hospital, this time with a diagnosis of abdominal pains of 
unknown origin. His history- in brief is taken from the records. 

Sept. 15, 1912. Ishi entered the University Hospital, the second time. The 
associate curator, Mr. Gifford, says that Ishi has a bad cold and has not appeared 
to be at all well for three daysc He refused to get up this morning. When 
questioned he complained of pain and tenderness in the left para-umbilical 
region. No satisfactory record of the condition of Ids bowels or of his appetite 
was obtained. He vomited a little clear fluid immediately after coming to the 
ward. 

The examination is as follows: 

Eyes. — ^Pupils regular and equal; react to light and accommodation. 

Nose. — Discharging mucus. 

Mouth. — The tongue clear. 

Breath.— T<iot foul. 

Tonsils. — Atrophic. 

Heart. — Negative. 

Lungs.— Both sides of chest move synchronously and equally. No demon- 
strable dullness. He complains of cramp-like pains in the left para-umbilical 
region; tenderness on deep palpation over area indicated on chart. [Cliart 
omitted.] 



178 University of California Publications in Am. Arch, and Ethn. [Vol. 13 

Abdomen.— 'So ilistontion. Rigidity, a little more on the right side than on 
the left. Doughy mass felt in region of ascending colon; some tenderness and 
stiffness on palpation over this area; seems to feel more comfortable with knees 
drawn up. 

Knee Jerks. — Positive and sluggish. 

Blood Examinution.—Red corpuscles, 4,800.000. White's, 10,000. Polynuclears, 
76%. Large mononuclears, 4%. Small mononuclears, 207f. Eosinophiles, nega- 
tive. 

U rinnl I/sis.— Pa\e yellow, clear. Specific gravity, 1015. Acid reaction. Sugar, 
negative. Albumen, negative. No casts. No red cells. A few round epithelial 
cells. 

Temperature. — Normal. 

Pulse. — Between 50 and 00. 

Ecspiration. — Between 15 and 24. 

DiscMrgcd September 18, 1912. Diagnosis: abdominal pains of unknown 
origin. Condition improved. Treatment: Calomel and Magnesium suli)hate. 

Islii's recovery from this attack was apparently complete, and he 
{rraduallv resumed his work as assistant janitor in the Museum. 



CHARACTERISTICS OF ISIII 

About this time I became an instructor in snrp:er}' in the University 
Medical School, and tlius came in contact with the Indian. 

From the first weeks of our intimacy a stronjr friendshi]) jrrew up 
between us, and I was from that time on his physician, his confidant, 
and his companion in archers'. He often asked if I were not part 
Indian, which, althouoh it is not a fact, I naively admitted I was. 

The Museum is near the Hospital, and since Ishi had been made 
a more or less privilepred character in the hospital wards, he often came 
into the surgical department. Here he quietly helped the nurses 
clean instruments, or amused the internes and nurses by singing his 
Indian songs, or carried on primitive conversation by means of a 
very complex mixture of gesture, Yana dialect, and the few scraps 
of English he had acquired in his contact with us. 

His affability and pleasant disposition made him a universal 
favorite. He visited the sick in the wards with a gentle and sympa- 
thetic look which spoke more clearly than words. He came to the 
women's wards quite regularly, and with his hands folded before him, 
he would go from bed to bed like a visiting physician, looking at each 
patient with quiet concern or with a fleeting smile that was very 
kindlv received and understood. 



1920] Pope: The Medical History of Ishi 179 



ISHI'S MEDICAL BELIEFS 

Women. — Ishi had many of our own obsolete superstitions regard- 
ing women. One criticism he made of the white man's civilization 
was the unbridled liberty we give menstruating women. The "Sako 
mahale," as he designated them, were a cause of much ill luck and 
sickness. They should be in seclusion during this period. In fact, 
he often commented on the number of sick men that came to the 
hospital. I asked him what he thought made so many men sick. He 
said it was "Sako mahale, too much wowi (houses), too much auto- 
mobile," and last but most important of all, the "Coyote doctor," 
or evil spirit. 

Dogs. — ^Playing with dogs, and letting them lick one's hand, Ishi 
said was very bad. He assured me that to let babies play with dogs 
this way led to paralysis. It is interesting to note that Dr. R. H. 
Gibson of Fort Gibson, Alaska, has reported the coincidence of 
poliomj^elitis among the Tanana Indians and the occurrence of dis- 
tempers in dogs.^ 

Rattlesnakes. — Ishi 's treatment for rattlesnake bite was to bind a 
toad or frog on the affected area. This is interesting in the light of the 
experiments of Madame Phisalix of the Pasteur Institute, who demon- 
strated the antidotal properties of salamandrin, an extract obtaiiied 
from salamander skin, and the natural immunity that the salamander 
has to viper venom. Macht and Able have obtained a similar powerful 
alkaloid from the toad Bufo nigra, called bufogin, which has some 
of the properties of strychnin and adrenalin. It has been used as 
an arrow poison by South American aborigines. Experiments which 
I conducted with salamandrin as an antidote to crotalin, show that 
it has a pronounced protective and curative value in the immuniza- 
tion of guinea pigs and in their cure after being bitten by the rattle- 
snake. It is, however, too dangerous and potent a poison itself to 
be of any practical value. 

When out camping we killed and cooked a rattlesnake or "kem- 
na. ' ' Ishi refused not only to taste it, but also to eat from the dishes 
in which it had been cooked. We ate it, and found that it tasted like 
rabbit or fish. Ishi expected us to die. That we did not do so he 
could only explain on the grounds that I was a medicine man and 
used magic protection. 



3 Journal American Medical Association, Feb. 28, 1914. 



180 Univcrsitii of CalifoniUi Publications in- Am. Arch, and Ethn.. [Vol.13 

Moon. — Ishi held tlie su 1)01-81 it ion common among uneducated 
Caucasians, that it is unwiiohsonie to sleep with the moon shining 
on one's face, so he coveivd liis liead completely under his blankets 
wlun sleeping in the open. 

llytjioic. — Ishi had wholesome notions of hygiene. When out 
hunting he has several times stopped me from drinking water from 
a stream whieh he thought had been contaminated by dwelling houses 
above. 

His resitlcnee in the .Museum caused many misgivings in his mind. 
The presence of all the bones of the dead, their belongings, and the 
imiimuies were ever a source of anxiety to him. lie locked his bed- 
room door at night to keep out spirits. When we stored our camping 
provender temporarily in the ]\Iuseum bone room, Ishi was not only 
disgusted by genuinely alarmed. It was only after the reassurance 
that the "bunch a mi si tee" could not enter through tlu tin of the 
cans that he was relieved. 

Surgery. — On some of his visits to the University Hospital, Ishi 
gazed through the glass-panelled door of the operating room and 
watched the less grewsome scenes therein, wondering no doubt what 
wiis the meaning of this work. At times, when it seemed proper, I 
took him into the operating room and placed him in the visitors' 
stand where he could watch the entire procedure of a surgical opera- 
tion. He was an attentive spectator, and his ([uestions afterward, 
though few and imperfectly understood, showed that he marveled 
most at the anaesthetic and that he debated the advisability of such 
surgical work. 

Once he saw me remove a diseased kidney. He viewed the sleeping 
man with deep wonder. He seemed interested at the methods we 
employed to prevent hemorrhage. For days afterwards he asked 
me if the patient still lived, and seemed incredulous when I said he 
did. When he saw an operation for the removal of tonsils he asked 
me why it was done. I told him of the pain and soreness which was 
indicative of disease, and necessitated the ojiei-ation. He conveyed to 
me the information that among his people tonsilitis was cured by 
rubbing honey on the neck, and blowing ashes down the throat through 
a hollow stick or quill; no operations were necessary. 

The only surgical operation with which he seemed familiar was 
scarification. This was accomplished by means of small flakes of 
obsidian and had as its purpose the strengthening of the arms and 
legs of men about to go out on a liunt. 



1920] Pope: The Medical History of Ishi 181 

Herbs. — His own knowledge of the nse of medicinal herbs was 
considerable, as we learned later when he went back to Deer Creek 
canyon with us on a three weeks' camping trip. Here he designated 
scores of plants that were of technical, economic, or medicinal value. 
But he put very little faith in these things. The use of herbs and 
drugs seems to have been the province of old women in the tribe. 

There was a hole in the septum of his nose which he had probably 
used as a receptacle for a small piece of wood, as well as for holding 
ornament,s. When he had a cold he placed in this spot a twig of 
bay wood or juniper, and indicated to me that this was medicine. It 
served very much with him as menthol inhalers do with us. Its 
influence was largely psj^chic but agreeable. 

Magic. — The real medicine was magic. The mysteries of the k'uwi, 
or medicine man, were of much greater value than mere dosing. 
Their favorite charms seem to have been either the blowing of smoke 
and ashes in certain directions to wield a protective or curative influ- 
ence, or the passing of coals of fire through themselves or their patients 
by means of sleight of hand. They also sucked out small bits of 
obsidian or cactus thorns from their clients, averring that these were 
the etiologic factors of sickness. 

The principal cause of pain, according to Ishi, was the entrance 
of these spines, thorns, bee stings, or, as he called them, "pins," into 
the human frame. The medicine man sucked them out, or plucked 
them while they were floating in the air in the vicinity of the sick 
man. They were then depovsited in a small container, usually made 
of the dried trachea of a bird, or of a large arter>\ The ends of this 
tube were sealed with pitch or some form of a stopper and the whole 
thing taken possession of by the doctor, thus keeping the "materia 
morbosa" where it could do no further harm. 

The fact that I was able to do sleight of hand : vanish coins, change 
eggs into paper, swallow impossible objects at will, and perform 
similar parlor magic, convinced Ishi that I was a real doctor, much 
more than any medication or surgery at my command. He came, 
nevertheless, to our clinic whenever he had a headache, or a bruised 
member, or lumbago, and accepted our services with due faith. His 
first attack of this latter complaint is recorded as follows: 



182 University of Califoniiu Publiviitions in Am, Arch, and Ethn. [Vol.13 

SICKNESS OF MAY, 1913 
Clinical Record 

Mail 21st, 1913. — Entered the hospital for the third time. Complaint, pain 
in the back. 

Eyes. — Exaniiuatiou shows pupils rog^ular and roaeting to light and accommo- 
dation. Eye muscles negative. 

Ears, Nose. — Negative. 

Skin. — Sclera. Mucous membraiio, negative. 

Th roat. — Negative. 

Tongue. — Slightly coated. 

Teeth. — Poor. Gums, pyorrhea. Purpuric spots on gums. [Probably a mis- 
take about pyorrhea.] 

Thyroid Gland. — Negative. 

Examin-ation of Chest. — Negative. 

Heart. — Apex not seen or felt. Dullness in the fifth space, 10 cm. from the 
middle lino to the left. No dullness to right of sternal margin. Sounds regular, 
good quality, faint, no murmurs. 

Pulse. — Radials equal, regular, good volume and tension. 

Abdomen. — Rounded, symmetrical, tympanitic; thick, flabby wall; no tender- 
ness. [He had become fat by this time.] 

Liver. — Dullness at the sixth rib intercostal margin in the nipple line. Liver 
edge, spleen, kidneys not felt. 

Back. — Apparently some rigidity of lumbar and also dorsal region, but im- 
possible to make sure of any real signs. No great tenderness. 

Blood Exa min-at io)i. — Negative. 

Vrin^alysis. — Normal. 

Temperature. — Normal. 

Diagnosis. — Myalgia. 

Treatment. — Acetyl-salicylic acid. 

Discharged, May 23, 1913, cured. 



ISHI'S PERSONAL HABITS 

Sleep. — In 1915, after liis first tubercular diagnosis, in order to 
keep liiiii in the most favorable environment, Ishi was given a little 
canva-s house on the hill back of the Museum. Here lie slept and spent 
much of his time. He had to be taught to keep his windows open at 
night, and even this outdoor sleeping did not please him. He always 
preferred to sleep in his old room on the second floor of the Museum 
where it was warm and dry. His bed was a canvas cot and he slept 
between blankets in preference to sheets. He had several flannelette 
nightshirts but he preferred to sleep naked, taking off all his clothes 
in the dark after his roommate, Mr. Loud, an attache of the Museum, 
had retired and extinguished the light. 

Clothing. — In the daytime he most frequently wore a khaki shirt 
and trousers, cotton socks and armv shoes. At first he was offered 



1920] Pope: The Medical History of Ishi 183 

moccasins, but he refused to wear them. He wanted to be like other 
people. Usually he wore a bright colored necktie and sometimes a 
hat, when he was going down town. In cold weather he wore woolen 
underwear, but he did not seem to need it. On rare occasions he put 
on an old raincoat in inclement weather. A few discarded woolen 
suits were given him, but cotton shirts and trousers were his choice. 
He used a pocket handkerchief in the most approved manner, and 
because of his frequent colds he needed it often. 

3Iodesty.—lshi, strange to say, was very modest. Although he 
went practically naked in the wilds, and, as described by Waterman, 
upon his first appearance in Deer creek canyon he was seen alto- 
gether nude, nevertheless, his first request after being captured was 
for a pair of overalls. He was quite careful to cover his genitalia 
when changing clothes, assumed protective attitudes, and when swim- 
ming in the mountain streams with us wore an improvised breech 
clout even though his white companions abandoned this last vestige 
of respectability^ 

ff^ilct.—Wlien well he bathed nearly every day, and he always 
washed his hands before meals. He was very tidy and cleanly in all 
his personal habits. When camping, he was the only man in our 
outfit who got up regularly and bathed in the cold mountain stream 
every morning. 

Ishi was an expert swimmer (plate 40). He used a side stroke 
and sometimes a modified breast stroke, but no overhand or fancy 
strokes; nor did he dive. He swam under water with great facility 
and for long distances. The rapids of Deer creek were rather full 
yet he swam them, and carried my young son hanging to his hair. 

Wlien he was sick he resented being bathed except when ordered 
by the nurse or doctor. Like many other primitive people, he con- 
sidered bathing injurious in the presence of fever. He never 
attempted to take a sweat bath while in civilization, but often spoke 
of them. I never saw him brush his teeth, but he rubbed them with 
his finger, and they always seemed clean. He washed his mouth 
out with water after meals. 

His beard was sparse but he plucked it systematically by catching 
individual hairs between the blade of a dull jacknife and his thumb. 
In his native state he used a sort of tweezers made of a split piece of 
wood. He did this work without the use of a mirror. 

He combed and brushed his hair daily. He washed it frequently, 
drying it by filliping it and beating it with a small stick as it hung 



184 Uuivcrsiti/ of California Publications in Am. Arch, and Ethn. [Vol. 13 

in the suuli^^iit. At first he had no dandruff, but after two or three 
years' contact with the whites he had some dry seborrhoea, and began 
to <ret a trifle jrray at the temples. I offered him bay rum to use on 
his hair, but lu> m-vcr adopted this effete innovation. He said that 
he used grease on his scalp when in his native state ; whereas bay 
leaves and bay nuts he said were heated and reduced to a semi-solid 
state, when they were rubbed on the body after the sweat bath. Here 
they acted as a soporific, or, as he said, like whiskey, and the person 
thus anointed fell into a sweet slumber. The same substance was 
rubbed on moccasins to make them waterproof. 

On one occasion he contracted ring worm, probably from a wan- 
dering cat. He was given a sulphur salve for this, and after its 
cure he still used the ointment to soften his hands, very much as 
ladies use cold cream. He assured me that it was good. He was not 
susceptible to "poison oak" {Rhus divtrsiloba) nor to sunburn. His 
skin bleached out considerably while in San Francisco, and became 
darker when exposed to sunlight. 

In his clothes box he kej^t several cakes of soap and seemed to 
have the same fondness for sweet-scented soap that Orientals manifest. 
Even talcum powder was there, which he called "lady powder." But 
I never saw him use either, and I ratlier suspect that the powder was 
a gift. 

His personal belongings he kept in a most orderly manner, every- 
thing in his box being properly folded and arranged with care. 
Articles which lie kept outside of this box he wrapped in newspaper 
and laid in systematic arrangement on shelves in his room. 

In working on arrows or flaking obsidian, he was careful to place 
newspapers on the floor to catch his chips. In fact, neatness and order 
seemed to be part of liis self-education. 

In the preparation of food and the washing of dishes he was very 
orderly and clean. In fact in the latter vocation he was by far the 
best artisan in our camp. 

Diet. — He was, at the time I first knew him. a man of medium 
stature, approximately 5 feet 6 inches tall, and weigliing about 165 
pounds. His weight varied greatly during his four yeare' stay with 
us. This was due to his changed methods of eating and exercise. 
At first he rather abandoned hinxself to tlie pleasures of an unlimited 
food supply. He fed at the nearby Hospital and had at least two 
full meals daily, besides a luncheon of his own preparation. This 
was greatly in excess of any dietan,' heretofore possible to him. In 



1920] Pope: The Medical History of Ishi 185 

consequence he increased in weight rapidly and became ungracefully 
fat. After a certain period of this luxury he discerned the folly of 
this course and began eating less, when his metabolism returned to a 
more normal balance. Part of this increase was due to the large 
quantities of water he drank. Being unaccustomed to salt, our 
seasoning was excessive and led to increased hydration of his bodily 
tissues. He had a great fondness for sweets: candy, jelly, cake, ice- 
cream, all were favorite articles of diet. He tried and liked nearly 
all kinds of foods, but seemed to have an aversion for custards, blanc 
manges, and similar slimy confections, nor could he be persuaded to 
drink milk. He contended that this was made for babies, while he 
said that butter ruined the singing voice. After some months of 
residence with us, he developed methods of preparing his own food 
in the basement of the Museum. 

By this time he was given a small salary for his services as janitor. 
He purchased his articles of food at neighboring grocery stores, indi- 
cating his selection by pointing his finger at the desired object and 
saying, "How much money-tee?" He learned to use a small gas 
stove for cooking. 

Matches he took up with evident delight ; they were such a contrast 
to the laborious methods of the fire drill, or of nursing embers, which 
he employed in the wilds. 

He bought bread, jelly, tea, coffee, sugar, canned salmon, meat, 
salt pork, sardines, cheese, potatoes, beans, rice, dried and fresh fruit, 
syrup, honey, and canned milk. This latter he took with his coffee 
until he discovered that it was milk, when he stopped using it. 

His frugality became a little too pronounced occasionally, and it 
was necessary to remonstrate with him on the matter. Usually he ate 
three meals a day : a very early breakfast, and two other meals at 
the usual hours. He was influenced probably by the work and meal 
hours of his companions. He cooked his potatoes by boiling them 
with the skins on and eating them dry. His meat he boiled only about 
ten minutes, eating it practically without seasoning. 

His own food in the wilds seems to have been fish, game, acorn 
meal, berries, and many roots. Prominent among these latter was the 
bulb of the brodiaea. The Indian could go out on an apparently 
barren hillside and with a sharp stick dig up enough brodiaea bulbs 
in an hour to furnish food for a good meal. These roots are globular 
in shape, with the appearance of an onion, ranging in size from a 
cherry to a very small potato. The flavor when raw is like that of 
a potato, and when cooked like a roasted chestnut. 



186 Universitj/ of California PubUv<itions ih Am. Arch, and Etitn. [Vol. 13 

Alcohol. — Tlie use of alcohol soon became known to Ishi, and early 
in his stay with its several immature persons tried to make him intoxi- 
cated, but a stop was very promptly called in this direction and tlie 
error of their ways pointed out. Ishi hiiiLself had no liking for 
strong drink, although at one time he purchased a few bottles of beer 
and drank small quantities diluted with sugar and water. He called 
it medicine. His response to my (piery regarding whiskey wa.s, 
""\\liiskey-tee cra^y-aunatee, die man." The sequence was strongly 
fixed in liis mind. No temperance lectures were necessary, although 
several goodhearted members of the W.C.T.U. attempted to instruct 
his primeval mind in these mattere. He had a fondness for ice-cream 
soda, which, with the moving pictures, constituted his entire accom- 
plishmentvS in debauchery. 

Tobacco. — Occasionally Ishi smoked a cigarette, and he knew the 
use of tobacco, ha\ang had access to the native herb in the wilds. 
But he seldom smoked more than a few cigarettes a day, and fre- 
quently went weeks without any. He disapproved of young people 
smoking. He chewed tobacco at times, and spat copiously. Both 
of these indulgences, however, he resorted to only when invited by 
some congenial friend. 

Etiquette. — Although uncultured, he very quickly learned the 
proper use of knife, fork, and spoon. His table manners were of 
the very- best. He often ate at my home, where he was extremely 
diffident; watched what others did and then followed their example, 
using gi-eat delicacy of manner. His attitude toward my wife or any 
other woman member of the household was one of quiet disinterest. 
Apparently his sense of propriety prompted him to ignore her. If 
spoken to, he would reply with courtesy and brevity, but otherwise 
he appeared not to see her. 

When he wanted to show his disapproval of anything very 
strongly, he went through the pantomime of vomiting. For instance, 
when he saw a callow youth with a mustache, for the first time, he 
expressed his disgust in an action which, interpreted, would corre- 
spond to our phra.se "that makes me sick." 

Thrift. — As janitor in tlie ]\Iuseum, he was making a competent 
income, understood the value of money, was very thrifty and saving, 
and looked forward to the day when he could buy a horse and wagon. 
This seemed to be the acme of worldly possession to him. He was 
very happy and well contented, working a little, playing enough, and 
surrounded bv friends. 



1920] Pope: The Medical History of Ishi 187 

ISHI'S DISPOSITION AND MENTALITY 

Disposition. — In disposition the Yahi was always calm and 
amiable. Never have I seen him vehement or angr>\ Upon rare 
occasions he showed that he was displeased. If someone who he 
thought had no privilege touched his belongings, he remonstrated 
with some show of excitement. Although he had lived in part by 
stealing from the cabins of men who had usurped his country, he had 
the most exacting conscience concerning the ownership of property. 
He would never think of touching anything that belonged to another 
person, and even remonstrated with me if I picked up a pencil that 
belonged to one of the Museum force. He was too generous with his 
gifts of arms, arrow-heads, and similar objects of his handicraft. 

His temperament was philosophical, analytical, reserved, and 
cheerful. He probably looked upon us as extremely smart. While 
we knew many things, we had no knowledge of nature, no reserve ; 
we were all busy-bodies. We were, in fact, sophisticated children. 

His conception of immortality was that of his tribe, but he seemed 
to grasp the Christian concept and asked me many questions concern- 
ing the hereafter. He rather doubted that the Wliite God cared much 
about having Indians with Him, and he did not seem to feel that 
women were properly eligible to Heaven. He once saw a moving 
picture of the Passion Play. It affected him deeply. But he mis- 
construed the crucifixion and assumed that Christ was a "bad man." 

Use of tools. — He was quite adept in the use of such simple tools 
as a knife, handsaw, file, and hatchet. He early discovered the advan- 
tages of a small bench vise, and it took the place of his big toe in 
holding objects thereafter. Larger bench tooks, such as the plane, 
the draw knife, the auger, the level, the square, and chisels, he rarely 
used. His measurements were made according to some dimension of 
his body, such as a palm's breadth, the length of his arm, etc. But 
he never counted paces or used any gauge for distances. Journeys 
were measured by days or sleeps. 

He was extremely apt at contrivance with small objects, and his 
hut building, as demonstrated both in civilization and by his lodges 
in the wilds, showed ingenuity and skill. With larger building, how- 
ever, he was not conversant. He marveled greatly whenever he saw 
carpenters construct a house, and was awe-struck when I took him to 
a sawmill where large cedar logs were brought in and rapidly sawed 
up into small bits to be used in making lead pencils. It would have 



188 University of Califoniia Publications in Am. Arch, and Eihn. [Vol.13 

taken hours for liiin to fell oven a small tree, and an interminable 
length of time to s))lit it. 15ut lierc was a miracle of work done in 
a few minutes. It impressed him greatly. 

Use of English. — He loved to joke, and looked at the "funny 
pictures" in the pai)ers, even laughing at some of the more obvious 
jokes. But lie either could not or would not draw pictures himself. 

With those whom he knew and liked he was remarkably talkative, 
randjling off into stories, descriptions, humorous episodes, and many 
unintelligible tales. When excited in liis description his voice rose 
to a faint falsetto. lie sweated with tlic ai-doi- of his portraiture. He 
went through descriptive pantomime. 

He labored with his simple tools of speech. Apparently he 
al)])reviati'd his vocabulary to fit our comprehension; and I know that 
he sometimes changed his pronunciation to conform to our imperfect 
command of his dialect. If we could not get the refinements of his 
articulation, he often used the word as we did so that there would 
be no misunderstanding. In a way he spoke "broken Yahi" just as 
we speak "pigeon English" to foreigners. 

He was a ])articular favorite with all small boys and from his 
many hours of conversation with them and with ^Museum visitors he 
learned much of his English. In consequence, his idioms had a flavor 
of slang, but were very expressive. Wlien an elderly lady interested 
in his soul, asked him if he believed in God, he replied, "Sure, Mike !" 

His English vocabularly l)y 1915 must have contained several 
hundred words and phrases. He knew the names of various 
peoples : English, Chinaman, Japanese, Wild Indian, Nigger, Irish- 
man, Dutchman, policeman. 

The following is an ai)i)roximate of his vocabularly: 

Hullo; nice day; too cole; too hot; too much watcr-t^'e; too much lazy-auna- 
tee; him lazy boy, smart boy; him crazy-auna-tee; hims good; hims no good; bad 
man; sleep; eat; work; sing; dance; I go; you go; you likey liim?; lice (rice), 
pishy (fish); bean-us; honey; labit (rabbit); big one; little one; led (red); 
white; black; hat-na (hat); shoes; camisa (Spanish for shirt); mahale (mujer, 
Spanish for woman) ; lopa (rope) ; lopa pikta (rope picture or moving pictures) ; 
candy-tee; soda wata; whiskey-tee; smoke; doctor; big cheap (big chief); dog; 
kitty-tec; coyote; chicken-a-tee; egg; apple; owanga-tee; lemon; barnarna-tce; 
cracker; soap; powder; medicine; chair; sit down; talk; how much money-tee?; 
money; shoot; cut em; die man (death) ; sick man; ole man; lady; mama; papa; 
sister; papoose (baby); too much I smoke (fog); I all a time smoke; put em 
away; you go get em; what's a matter-tee?; you go pretty soon; long time; 
automobile; horse; telephone; fire; pistol (gun); pike (fight); evelybody happy ; 
him cry; too much pina (pain) ; sheep-na; paka (vaca, cow) ; tea; koppy (coffee) ; 
milik (milk) ; nipe (knife) ; axa (axe) ; hatch (hatchet) ; papello (paper) ; 
light; all a same. 



1920] Pope: The Medical History of Ishi 189 

The Indian had no set phrase of greeting as we understand it. 
If we insisted upon it, he would say "Hullo," and as for a parting 
phrase, he never said more than "You go?" If one said "Good bye" 
to him, he remained silent. If he was forced to speak, and in later 
years he seemed to underetand that some response was expected, he 
would say "Good boy," and undoubtedly meant it as a complimentary 
expression. It seemed to have no such meaning as it implied in our 
language "God be with you." 

He never learned to say ' ' Thank you. ' ' If he valued your service, 
he smiled. If your present pleased him he said, "Him's good!" 

Knoivledge of reading and figu)rs.~B.e learned to sign his name 
on his cheques, and I have preserved one of his signatures. No 
attempt was made to teach him English or reading. 




He could distinguish numbers to the extent that he could be trusted 
to ride alone on street cars bearing certain numerals, such as car 
No. 6 or car No. 17, both of which carried him from the ferry to his 
home. In a way he could tell the time by the clock. He knew midday, 
and any hour one pointed out to him, and he could be depended on to 
act on time. He carried a cheap watch some one had given him. It 
had a large chain and pendants attached. He wound it faithfully 
every day, but it was never set properly, and consequently was more 
of a comfort than a help. Nevertheless he was veiy proud of this 
possession. 

An estimate of character. — I once took him to Buffalo Bill's Wild 
West Show. He always enjoyed the circus, horseback feats, clowns, 
and similar performances. AVhile at the show we were watching some 
Plains Indians dress for their performance. A very dignified warrior, 
bedecked in all his paint and feathers, approached us. The two 
Indians looked at each other in absolute silence for several minutes. 
The Sioux then spoke in perfect English, saying: "What tribe of 
Indian is this?" I answered, "Yana, from Northern California." 
The Sioux then gently picked up a bit of Ishi's hair, rolled it between 
his fingers, looked critically into his face, and said, "He is a very 
high grade of Indian." As we left, I asked Ishi what he thought 
of the Sioux. Ishi said, "Him's big cheap (chief)." Apparently 
their estimates were equally complimentary. 



190 Universiiy of California Publications in Am. Arch, and Ethn. [Vol.13 



CLINICAL HISTORY, MAY, 1914 

At tht' height of Ishi's ])hysieal pcrfi-ctioii I rocordcd the follow- 
ing:: 

AVe know iiothiii<r of the parentage of our .subject. He was bom 
probably about 1860 in northern California, consequently is approxi- 
mately 54 years of age, but appears about 45. There is no record 
of childhood diseases. 

He shows no signs of ehickenpox or smallpox. No suppurating 
glands, boils, burns, or scars of any sort. His skin is light, reddish 
bronze, soft, sparsely endowed with hair. 

The odor of his body is faintly musty, and suggests the smell of 
tanned deer hide. Bones small. Musculature is well developed, with 
an even distribution of subcutaneous fat. The hair of his head is 
black, straight, and of medium weight, slightly gra}^ at the temples; 
in length it reaches his shoulders, having but recently been burnt 
off as a sign of mourning. He wears it over his ears, tied in a single 
brush down his back. The scalp shows some evidence of dry 
seborrhoea. His head is of the brachycephalic type. The measure- 
ments are as follows : 

Length of head, 193 mm. 

Breadth of head, 163 mm. 

Cephalic index, 84.4 mm. 

Length of face, 131 mm. 

Breadth of face, 152 mm. 

Length of nose, 54 mm. 

Breadth of nose, 42 mm. 

Nasal index, mesorhynian, 77,7 mm. 

The skull is strongly made, with thick supraorbital ridges, mastoid 
processes, and external occipital protuberance. The jaws are strong 
and heavy. Tlie teeth are all present, strong, colored slightly brown, 
no evidence of decay or pyorrhoea. The alignment of the lower 
incisors is not perfect. The molars are well worn but in good con- 
dition. Ears are well formed, of good size, and the lobes are pierced 
for rings. The eyebrows and lashes are of moderate length and 
thickness. The eyes are set straight, lids Caucasian in contour. The 
iris is dark brown ; reactions to light and accommodation are normal. 
The nose is strong and wide, the septum pierced just above the 
cutaneous margin for the insertion of a small stick. 



1920] Poj)e: The Medical History of Ishi 191 

The tongue is clean and normal in color, no coating. The tonsils 
are slightly hypertrophied, showing signs of past inflammation. His 
breath is sweet and free from the fetor common to the average white 
man as noted by Powers.* 

There are no enlarged glands in the neck, the thyroid is normal. 
No abnormal pulsations occur in the vessels. The neck is full and 
strong. There is a slight pad of fat over the seventh cervical vertebra. 
The chest is full, normal in shape, breasts a trifle large compared to 
Caucasian male standards, aerola not haiiy, no axillary glands are 
palpable. 

On percussion the lungs are noi-mal ; osculation is negative. The 
diaphragm moves equally on the two sides. The heart outline on 
percussion is normal, sounds normal. The pulse is 65 ; blood pressure 
125 mm. ; arteries are soft ; pulse compressible, regular, good volume. 

The abdomen is negative except for some tenderness in the right 
hypochondriac region. There is a slight surplus of fat. No disturb- 
ances of digestion, no flatus or constipation. Good appetite, regular 
habits. Abdominal reflexes normal. 

The genital region is normal. No hernias nor enlarged glands 
exist. The genitalia are rather small but of normal character; pig- 
mentation is accentuated in this region. He gives no history of 
venereal infections, but knows of their existence in a vague, general 
way. He seems to have had little actual experience in sex function ; 
was never married, he says, because there were no marriageable 
women in his tribe. There are no urinary disturbances ; no nocturia ; 
apparently he is free from perversions. 

The cremasteric reflex is normal. The thighs and legs are well 
formed. Knee jerks normal. The feet are broad and strong (plates 
42 and 43). The toes are straight and unspoiled. The longitudinal 
and transverse arches are marvelously well preserved (plate 42, fig. 3). 
His abductor pollicis is very pronounced in its development. The 
foot is a beautiful example of what the human foot should be. His 
method of locomotion is that of rather short steps, each foot sliding 
along the ground as it touches. Neither the heel nor the ball of the 
foot seems to receive the jar of the step. The foot is placed in 
position cautiously, not slapped or jammed down. He progresses 
rather pigeon-toed, and approximates crossing the line of his progress 
each step. He springs from the great toe, which is wonderfully strong 



4 Stephen Powers, Tribes of California, Contributions to North American 
Ethnology, 1877, ni, ch. 34, p. 403. 



iJtL' I'nivcrsitt/ of CalifoniM Publk'utwns in Am. Arch, and Ethn. [Vol. 13 

in its plantar tlcxion and aluluction (plate 43, fig. 1). The plantar 
reflex is active. The skin of the sole is thiek but not rough (plate 42, 
fig. 1). The toenails are round in outline, strong, and short. 

He is not an agile runner nor does he have the spring and leg 
action of one who in his 3'outli had been a sprinter. His stride is 
rather restricted and he laeks a vigorous thrust of the legs. The knees 
are not drawn up well in front. He has considerable endurance, and 
at walking he never seems to tire. 

The spine is normal in contour, with a slight drooping of the head 
forward. The hnnl)ar flexion is somewhat limited and he is subject 
to attacks of lumbago of mild degree. The pelvis is of generous pro- 
portions, strong. The sacro-iliac joint is firm, with no evidence of 
relaxation. 

The hands are medium size, probably a numb(>r 8 glove. The 
fingers are gracefully tapered, pleasing in shape, witli fingernails 
olivoid in outline, perfect in texture. The palms are soft and pliable. 
He is right handed. His grip at this time with the dynamometer 
registers as follows: Right hand 49 kilograms, left hand 45. These 
are maxima of many attempts. 

He is a good informal wrestler, and scuffles with the men with 
evident delight. In the game in which two oj)i)onents clasp right 
hands, then attemi)t to upset the stand of the other, he is strong but 
awkward. He can box with the open hand in a deft though unskilled 
manner. He rather likes games of this sort, but no acrobatics appeal 
to him, nor does he ever attempt to exhibit his strength. He throws 
stones rather poorly, not with the strength and accuracy of one 
accustomed to games of ball (plate 39). 

About this time Ishi was successfully vaccinated, and passed 
through the inoculation without trouble of any sort. In fact his 
health seemed improved after this procedure. 

Ishi was vigorous, and a good worker when working with others, 
but indifferent to the beauty of labor as an abstract concept. He 
never fully exerted himself, but apparently had unlimited endurance. 
When fat he perspired freely. After a three weeks' trip in the 
mountains he was in the pink of condition and could journey all day 
without effort. He was at this time— May, 1914— undoubtedly in 
better health than at any time during his stay with us (plates 39, 40, 
and 41). He had had several respiratory infections, but up to this 
time he showed negative tubereuline reactions and there was no pre- 
monition of the illness which later caused his death. 



1920] Pope: The Medical History of Ishi 193 

Every effort was made to keep him in good health. He was encour- 
aged to stay outdooi-s; he was kept away from infectious diseases. 
His diet was ample. He was given perfect freedom. When asked 
if he wanted to return to the wilds, he replied that he did not, because 
everybody was dead, only evil spirits inliabited the places of his 
former pursuits, and there was not enough food to eat there. 



SICKNESS OF DECEMBER, 1914 

In the winter of 1911, a change seemed to be taking place in our 
informant. He became listless, less inclined to bestir himself, com- 
plaining of various obscure infirmities. He seemed, to members of 
the Museum staff, to be growing darker in complexion. He had 
obviously lost weight, and coughed. In consequence of liis unsatis- 
factory physical condition, he was entered for a fourth time in tlie 
University Hospital. 

His clinical history is as follows : 

Js/(.(,.— Number 8371. December 10, 1914, to February 1, 1915. 

Family History. — Unknown. 

Past History.— Fatient has been in U. C. Hospital, Medical Ward, on two 
previous occasions, Nov. 22, 1911; Sept., 1912. 

Present Illness. — Complaint: pain in abdomen. Pain beneath sternum and 
in upper dorsal vertebra. For past month it has been noted by the Indian with 
whom Ishi is associated that his skin is becoming darker. He has complained 
occasionally of headache and pain in back of neck. He has been attending the 
Medical Out-Patient Clinic for past 3 weeks, since about Nov. 20, and during 
this time he has been constantly tender over the gall bladder area. Slight cough 
present for past two weeks since about Nov. 27, also marked constipation and 
anorexia. 

Physical Examination. — Patient dark skinned Indian, lies comfortably in bed. 
Expression rather apathetic. He is well developed and well nourished. The 
muscles are slightly flabby. Skin very smooth. Neck is very short. Face broad 
with high malar prominences. Eyebrows thick, hair thick and long. Nose shows 
prominent alae nosae. Ears normal. Eyes: pupils round, react to light and 
acconmiodation. Mouth: large teeth in good condition. There are two small 
pigmented areas at the gum line of lower incisors. Tongue large, covered with 
grayish white material. Thyroid: lateral lobes just palpable. Right axillary and 
epitrochlear glands palpable, hard and shotty. Inguinal glands palpable. Caro- 
tids: left smaller than right. 

Chest. — Symmetrical, slightly bowed, prominent 7th cer\ical and 1st dorsal 
vertebra with thick pad of fat covering. Expansion equal and fair. Supra 
clavicular fossae prominent. 

Lungs. — Resonant throughout. Breath sounds rather faint over both lungs. 
On coughing and deep breathing there are a few moist crackles just below spine 
of scapula, right lung, and over base. 



194 Uiiivcrsitu of Calif oniia ruhUnitioiis in Am. Arch, and Kthn. [Vol.13 

Utart. — Cardiac iIuHik-ss f.\t«'ii«ls from :^r.l ril> alxive to 9.'. iiii. on the left 
at li'vi'l of 'dh rib ami 2.;") to riKht of mid sternal line. The apical impulse not 
siH'u is felt as feei>le lo<^'Jilized impulse in 'Ah space inside nijjple. Sounds are 
of faint <iuality best heard at pulmonic area. 

Pulst: — Rate 70, e(|ual, of f:iir volume, and low tension. Artery \v;l11 not 
sclerosed. 

Abdomen. — Slightly prominent, symmetrical, moves freely with respiration. 
On palpation there is slijjht resistance in the epijjastrium and there is a definitely 



Rales ^ 




Diminished breatn sounds 
Halea 



Tenclerness on 



deep pressure . 



Fi;r. 1. n,;iit of Dec. 10, 19U 



tender area on deep pressure just below the costal border rifjht side, in mid 
clavicular lino. One cannot feel a definite mass here but the cdfje of the liver 
is palpable just internal to this i)oint. The lower half of the abdomen is soft. 
There is no dullness in the flanks. 

Jiectal Kxamimition. — I'rostute slijifhtly enlarj^ed, otherwise ne{j;at.ive. 

Back. — No dorsal ti'iider points. IS'o tender vertebra. 

Extremities. — Normal. 

Reflexex. — Normal. 

Dec. n. — Patient {riven 2 nu p. O. T. (Old Tuberculin). 

Dee. 14. — Durinjj jiast 48 hours there ha-s been a rise in temperature over two 
degrees with rise in jiiilse rate, a niiuked reaction, a niarkcil increase in sputum 



1i)L'()l 



Pojir: Th( Medical TTi.s-lorif (if Ishi 



195 



nil. I in physiciil si^;us, c.fj:., moist crt'pitat ions on cou.nhini;-, liciird over rifrlit jipcx 
])osti"iioily and ovor riylit haso. 

/>,.,, /7, — Tuberculhi (von l'ii(|iu'1. ) : iiositivc in luininn ami bovine after 4S 
hours. Luno-s still show dullness at. ri«ht. ajx'x and at riuht. i>ase with a few rales. 
Sputum is larf;o in amount. 




[Breath sounds 

diminished 
Showers of rales. 

crepitation on 
g and deep 
g.Dull percussion 
note. 



^i 3 
Fi^-. 2. Chart of Dee. 2:',, lit 11 

Dec. ID. — E.xainination of ears: negative. Examination of nose: turbinates 
enlarged and relaxed; slight amount of mucoid discharge on inf. turb. lOxani- 
ination of throat: tonsils relaxed with largo dilated vessels. Wassermann on 
Serum, number T.l^l : negative. 

J)cc. 2U. — Temperaturo has risen to-day and patient feels poorly, lie was 
taken down to clinic yesterday for nose examination and possibly exertion was the 
cause of rise in temperaturo. 



190 I'niversUi/ of California Publications in Am. Arch, and Ethn. [Vol.13 

Bee. S3. — Breath sounds over entire riglit lung accompanied by showers of fine 
ralea. Slight dullness at right base. No friction rub heard. (Dr. Allen.) 

Dec. 28. — Although the temperature is now normal there still remains dullness 
at the right base and showers of fine rales over both bases. 

Jan. 4, 1915. — Patient is feeling much better during last few days. Right 
base still shows some dullness and fewer rales are heard over right lung than 
before. The sputum raised is still large in amount. 

Jan. 8. — Patient has been running slight temperature for past five days. Pulse 
slightly elevated. He complains of sharp stabbing pain over gall bladder region, 
especially on coughing. Copious sputum present, about 350 c.c. in 24 hours. There 
is no loss of weight. 

Jan. 11. — Dr. Allen finds the same signs at right base as existing at last 
examination. The patient raises a large amount of thin greenish sputum. 

Jan. 12. — The liver edge is palpable 3 finger breadths below costal border in 
mid-clavicular line. The notch is palpable and there is distinct tenderness over 
the gall bladder region. The gall bladder is not definitely palpable. 

Jan. 19. — Sputum report: smears of sputum stained by acid fast method were 
negative. Treated with antiformin and after centrifuging, sediment was mixed 
with 5 e.e. of salt solution and injected intraperitoneally into a 320 gm. guinea 
pig — black and yellow angora. One month later : autopsy of guinea pig showed 
no tuberculosis. Diagnosis: negative for tuberculosis. 

Jan. 21. — Liver has receded, edge just palpable beneath costal border. Ten- 
derness over gall bladder area persists. Diminished breath sounds, dullness on 
percussion and many fine and medium moist crepitations on deep breathing still 
present at right base posterior below 8th rib. Sputum for past 2-i hours, 350 c.c. 

Jan. 25. — Dr. Mofiitt finds dullness on percussion, diminished breathing, and 
fine crackles over right base. Also dull percussion note in right axilla as high 
as 4th rib. This dullness is not made out in the sitting posture. The liver feels 
somewhat nodular. The notch is felt. 

Jan. IS. — X-ray of chest. Diagnosis: glands at right root and few small 
ones at left. (Dr. Ruggles.) 

Feh. 1. — Patient discharged. Improved. To report back to hospital. 

Diagnosis. — Respiratory infection of undetermined etiologj'. Positive tuber- 
culin reaction. 

This sickness marks an epoch in the life of Ishi. Retrospectively, 
it is very evident that his active tuberculosis starts from this date. 
Here for the first time we have accurate data indicative of the nature 
of his infection. His subcutaneous tuberculin reaction is strongly 
positive. His dermal reaction is confirmatory. 

It is strange, however, that with all the subseciuent findings no 
evidence of tubercle bacilli in his sputum could be demonstrated by 
microscopic search nor animal inoculations at this period. 

The persistent pain below his right costal margin, so often referred 
to as a possible gall bladder lesion, from this time on becomes a con- 
stant feature of his symptoms, and is only explained by the final 
protocols. 



1920] Pope: The Medical HiMonj of Ishi 197 

3 ^^isppo^ Ji p> 



^ 




^ 


^ 


^ 


p 




P 


P 


P 


r*- 


Ofq 


r<- 


c1- 


c-*- 


rD 


■-S 


rt! 


ru 


a> 


i-j 


P 




■-! 


■-! 


M 


V! 


^ 


^ 


t<j 



CO g 



P crq 



fo 


fp 


p 


p 


a^ 


c<- 


& 




"E 


3 

rr' 



o 05 p 



Q 



o c 



tt ^. 



&- O 






bj 



^■ 


1^ 


1^! 


^ 


B 


c 


Ci 


c 


<v 


H 






c^ 


C^ 


d^ 




ro 


o' 


o 


p 




a 


a 



!z! !z; !z; ;z; >s 



B ^ ^ 



^ 



2 P 






M S 



S? fe^ 



**1 





o 

CO 


ci 


b 


w 




C 


S 


H? 


f 


P 




1^ 

P 


o 

o 




td 




H 


H 


fe; 


X 


P 


X 


K< 


o 


> 




> 



p s 



a ■ o ►So 

w ^ ^ on? :^ tfi 







^ 


t-^ 




P 


O 


>-i 


?i 


0«3 




rti 


o 

M 


B 


P 


o 






198 University of Califoniiu Publications in Am. Arch, and Ethn. [Vol. 13 



TSIirs KIXAI. SICKNESS, 1915-1916 

Ishi's last sickiKss, to all visible sigrns, started in the summer of 
1915. lie had been ailing all winter and .showed an increased disin- 
clination to .shoot his bow or bestir hinLself. 

In the sinnmer vaeation of this year Ishi was moved to Berkelej', 
wiiei-e he was studied by Dr. E. Sapir, and very valuable data were 
obtained on the subject of his lan^ua<2:e and mytholojry. For three 
months he was in constant coiniiiuiiication with Dr. Sapii', liviii"^- at 
Profis.sor T. T. Waterman's home under most hygienic conditions with 
plenty of outdoor reei-eation, sleeping, proper food, and diversion. 
Nevertheless, his health suddenly began to fail, and on August 22 
he was returned to tiie I'niversity Hospital in San Francisco, where 
he remained for six weeks. The history of this period is as follows: 

Ishi.— No. 9773. August 22, 1915. 

Present Illness. — Since leaving the Hospital Jan. 29, 191.J, patient has been 
sleeping in open air and general measures taken to overcome his tendency to 
respiratory trouble. During the past several mouths he has been in Berkeley 
where he was carefully looked after. 

Several weeks ago he began to cough and complain of pain with breathing on 
left side of chest. He was examined by Dr. Pope about 10 days ago but nothing 
was found. Cough slight but constant. 

Cough continued and, within the last week, he felt a sliaip pain in left shoulder 
extending to left base in front with coughing on deep breathing. 

The last few days the cough became so severe that he was sent to Hospital 
today. He has felt generally indisposed and has apparently lost some weight. 

Plii/sical Examinution. — Medium sized, well built, dark skinned Indian, fairly 
well nourished, with long lilaik liair in "pigtail'' down back, j)roniiuent clitH^k 
bones, broad features, large, long nose. Patient lying in bed comfortable; not 
especially sick looking, coughing frequently very hard. 

Ears and Nose. — Negative. 

Eyes. — Sclera muddy. Pupils large, equal, circular, react to light and dis- 
tance. Eye muscles negative. 

Mouth. — Tongue moist, coated, large circumvallate pai>illae. Teeth not very 
good. 

Tonsils. — Not remarkable. 

Neck. — A large, soft lymph node on each side of neck front of sterno-mastoid 
just beneath angle of jaw. No epitrochlear glands palpable. Thyroid, negative. 
Carotids palpated, equal and synchronous. No remarkable neck pulsations. 

Chest. — Well formed and developed. No pulsations. Thin body hair. 

Lungs. — Dullness as shown in chart. Breathing harsh over right side; very 
diminished and absent at left base. At left base suggestion of bronchial quality 
to breath sounds with cough. 

Heart. — Apex not seen nor felt. Dullness in 5th space 10 cms. to left of 
midline (1 cnu inside nipple line), above at 2nd space at right sternal border. 
Sounds regular, good quality, faint No murmurs. Aortie and pulmonary sounds 



19201 



Pope: The Medical Historij of Ishi 



199 



are not accentuated. Eadials, equal, regular, good volume, and tension. Artcry 
walls soft. Bate 80 per minute. 

Abdomen. — Soft, tympanitic; not tender. 

Liver. — Edge felt 4 cm. helcw right costal margin in nipple line. Irregular 
mass or edge in mammary line. 

Bad'.- — Negative. 

Extremit ies. — Negative. 

Ecflexes. — Triceps, biceps, radials, patellae equal and positive. Abdominal 
and cremaster lively. No Babinski. 



Questionable 
egophony 



uullnesSjdiminish 
breath sounds jiui 




Few scattered 
crackling rales 

Dull 



-?>»-} 



Fig. 3. Chart of Aug. 23, 1915 



Blood Count.— Bed cells, 6,000,000. White cells, 10,600. Differential leuco- 
cyte count: Neutrophiles, 75%. Eosinophiles, 2%. Basophiles, 0. Small lympho- 
cites, 10%. Large lymphocytes and transitional, 12%. Myelocytes, 0. Parasites, 
none. 

Urinalysis. — Specific gravity, 1010. Reaction, acid. No albimien, no sugar, 
no pus. 

Simtum Examination. — Gray tenacious, great deal of thin mucus. No tubercle 
bacilli, streptococci, long mycelia-lrke threads, many epithelial cells, few pus 
corpuscles present. 



200 



University of Calif oriiin PuHieations in Am. Arch, and Ethn. [Vol.13 



Aug. 23.— Dr. Allen fiiuls sigus in lungs mueh as oiitline.l above and thinks 
there is fluid at left base, with diffuse crackling rales at right base. 

Aug. f^.— Tuberculin skin test: positive to human and bo^'ine in 24 and 48 
hours. Markedly positive: liuman l.j cm. X l.o cms. Bovine 1.3 X 1 cm. in 
diameter. 

Aug. ;?5.— Tshi brings up ([uit*^ a lot of gray tenacious sput^i. He coughs less 
than before but still oft^^u during day an.l fairly hard, complains slightly of 
pain with cough. Not dyspnoic and apparently comfortable. No T. B. bacilli 



Mass attzuilied 




to liver 



Dull 

Doubtful pleural rub 

Flat,diminbbed 
breath rounds and 



(A^ 



Fig. 4. Hiart of Aug. 2(5, 1915 



found in sputa, but a plentiful mixed flora of fusiform bacilli, spirochetes, cocci, 
and many large rods with mycelial morphology' found. 

What is probably a pleural-pericardial rub is heard over area of absolute 
cardiac dullness, synchronous with heart beat upon inspiration, disappearing with 
cessation of breathing. Dullness at left base and general signs here increased 
greatly. 

Patient has had hiccouglis since 12 p.m. last niglit, but finally checked this 
P. M. with validol and sugar. 

Aug. 26. — A marked change in lung signs in front has occurred since yester- 
day. The whole left chest in front is dull, except Traube 's semilunar space, 
which is not obliterated. Heart not pushed to right. 



1920] 



Fope: The Medical History of Ishi 



201 



Dr. Moffitt finds conditions as outlined on charts. Tlatness and signs suggest 
fluid with a peculiar distribution. The fact that heart is not pushed to right 
would indicate old adhesions. No pleural pericardial rub heard today. Sudden 
onset of condition in upper left thorax niight suggest a localized pneumo-thorax. 
Amphoric egophony made out with crepitations above the fluid. 



ulljdim'inisneQ 
kreath sounds and 
remitus. 




flat, 

aim'inisheci 
reatn sounds and 

vocal fremitus, 
in sounds Left 
argerinan ri^ht. 



Fig. 5. Chart of Aug. 26, 1915 

Dr. Allen finds very distant .bronchial breathing, as if through fluid over lower 
left lung. Eiglit side harsh breathing. Left top in front is dull, with character 
of high tympany. 

Patient tapped this afternoon. Needle inserted in 6th space in midaxillary 
line. Fluid appeared immediately, 1600 c.c. of a clear straw-colored fluid with- 
drawn and as patient beg'an to cough a little, needle withdrawn. Needle then 
inserted in 3rd space in midclavicular line (as dullness over left top still persisted) 
but no fluid found. Still fluid at base. 

Chest fluid: 1600 e.c. clear, straw-colored (a little dark). 



202 



Vnivcrsity of California Publications in Am. Arch, and Eihn. [Vol. 13 



Revolta doiiblo positive; specific fjravity 102t); coagriiluni (luit-kly forms. 

Albumen. Cell coiiiit : Lymi>liocytes 90..'>9'f ; polymoi])ho 7.(5%; eosinophile 
1.6%; endothelials l.ti^r. 

Hiccoughs continue. Only temporarily relieved by medication. 

Aug. 27. — Left lung top below clavicle again dull this morning with a high 
tympanitic note. Some resonance still found in left axilla as after tapping, 
although less tliaii right after tapping. 



lyper. 

resonance 




flal.diminished 

realh sounds 

.and vocal 

fremitus. 



as5 attached to liven 



Fig. 6. Chart of Sept. 2, 191,3 



Percussion of back shows condition practically the same as shown on last 
chart. Hiccoughs have continued all through night and today, only temporarily 
relieved by any medication. 

Sept. 2. — Hiccoughs have continued with intermissions. Stopped for a few 
hours by morphine. Fluid has apparently receded a little at the left base behind. 

The tympanitic note over left upper chest still remains and has apparently 
become a little more marked. This area above cardiac dullness still remains very 
flat; but below in left axilla fair resonance is still found as after tapping, shading 
off into flatness at extreme base in axilla. Breath sounds heard but diminished. 
Traube 's space clear, heart not displaced to right. 

In the back, the flatness at left base is lower than l)efore and the relative 
dullness above does not extend so high. Voice and l)reatli sounds are still 



1920] 



Pope: The Medical Ristory of Ishi 



203 



dimiuished at left base but much louder than before. Many crepitant and 
crackling rales heard over whole area, especially at base. Here fluid has appar- 
ently receded. 

Sept 4. — Physical signs about same. Hiccough only at short intervals. Cold 
in head and sore throat. Left tonsil red with a few white patches. Complains 
of headache. 



Dullness with 
breatli 




rackling rales 
ght dullness. 



Fisr. 7. 



7>i« 
Chart of Oct. 5, 1915 



Sept. 7. — Exploratory thoracentesis with Luer syringe for withdramng fluid 
and injecting subeutaneously. Needle inserted in 9th space in line with angle 
of left scapula, but no fluid found. Dullness still persisted up to 8th space, but 
not the absolute flatness encountered before. Breath sounds louder at left base 
with many diffuse rales at line of dullness and below, and faint bronchial breath- 
ing. Dullness at left top in front with less tympany. Left axilla fairly resonant. 

Sept. 8. — Tympany gone from left lung. Fluid receding. 

Sept. 16. — X-ray: increased density at left base, probably fluid. 

Sept. 17. — Dr. Moffitt finds whole mediastinum shifted to left. 

Condition apparently localized effusion at left top. 

Very few signs in lung itself. 



204 University of California Publications in Am. Arch, and Ethn. [Vol.13 

Sept. S9. — Patient still hiccoughs for short spells each day. Today hiccough 
has clonic character, occurring in groups of 3 and 4 together Avith a pause after 
each group, like a tic of the diaphragm. Left apex still dull with characteristics 
of walled off fluid. Heart apex impulse seen at nipple line. 

Dr. Moftitt thinks the signs are very unusual for tuberculosis. There must have 
been shrinking with pulling of heart up and walling off of Traube 's space. 
Evidently there is some encapsulated fluid at the left apex. Carotids are small 
and equal, evidently size of ordinary radials. Radials smalL Feniorals are large. 
Marked discrepancy between radials and femorals in size and pulsation on left. 
Radial systolic blood pressure equal 100; femorals systolic equals 132 kg. 

Pigmentation of body seems generally deeper than formerly. 

Electric reaction of phrenic: with stimulation of phrenics in neck, diaphragm 
responds to both galvanic and faradic currents, with a single contraction for each 
breaking or closing of current. The response is more easily elicited and seems 
stronger on right side than on the left. 

Oct. 5. — Dr. Allen finds apex impulse very marked under the nipple but the 
nipple is in the 5th space. Heart seems to have been drawn up slightly. 

Whole right side moves more than the left; hyper-resonance on the right. At 
left apex in front fair resonance just above and below clavicles but at level of 
2nd space flatness begins and extends out to 5th space in axilla. Below this 
level there is tympany on the left. Respirations very faint over this flat area. 

Over back, whole left lung is dull but no flatness except at extreme left base. 
Dullness increases toward base. Probably no fluid now at left base. Dullness 
with persistent crackles over right apex. 

Gall bladder still palpated. Mass just below liver, attached to liver. 

Oct. 6. — Discharged improved but still vrith definite signs of trouble in both 
lung.s. Ishi is to be removed to a room in tlio Museum, where he can get more 
fresh air and sunshine with special arrangements for supplying him with food 
more suitable to his taste. After becoming stronger, he has been advised to 
return to the country and mountains and live more as he did formerly. 

Diagnosis: pleurisy with effusion; chronic pulmonary infection of unknown 
nature. Probably tuberculosis of the lungs. Improved. 

Chief of Medical Staff: H. C. Mofkitt. 

Assistants: W. H. Allen, E. S. Kilgore, J. L. Whitney. 

Resident: E. K. Falconer. 

Internes: F. H. Kruse, A. H. Maxwell. 

Temperature during tliis time was of the tuberculous type with 
reguhir afternoon rise, and ranged between 37 and 38.6 C. His pulse 
ranged between 60 and 65 per minute ; respiration between 16 and 25. 

His medical treatment was directed most toward the relief of his 
distressing hiceougli. He was given elixir terpciic hydi'atc; validol ; 
bismuth siibnitratc ; eliloratone; chloral and bromides; morphine — all 
with little success. 

An occasional laxative was ordered. His appetite was capricious. 

His weight fell from 65 kilograms to 60. 

A note appended to the record is as follows : 

Feb. 9, 1916. — Ishi has been in a room in the Museum since leaving hospital. 
He has continued to run a temperature of 101 to 103" F. in the afternoon rise; 
coughs a little and has been kept closely in bed, with liberal diet and hygienic 



1920] Pope: The Medical History of Ishi 205 

measures against tuberculosis. There are still indefinite signs of trouble at right 
apex with dullness up to 9th rib at left base, and the flat area over left front 
near top. Lung signs have not cleared much, if any. 

At the expiration of his stay in the hospital, in October, Ishi was 
removed to temporary quarters arranged in the Museum, where he 
could have a large sunny room, well ventilated, and be attended by 
Mr. Warburton, an attache of the IMuseum. It was planned that when 
he became a little stronger, he should be sent to the country, some- 
where near his old haunts, and several possible places were considered. 
Tentative arrangements were made with responsible caretakers, but 
he never grew strong enough to travel. 

During his months of sickness in the Museum, his clinical records 
were faithfully kept by Mr. Warburton, and Dr. Kruse and I were his 
constant medical attendants. In spite of careful nursing he failed to 
improve. No medical treatment being indicated, he was given prac- 
tically none. His appetite became more capricious and fickle. Food 
distressed him, and he required anodynes at times to relieve his pain. 
His fever persisted in a tuberculous type and weakness became 
extreme. For hours he lay without moving, often gazing from his 
window and smiling with manifest delight at the antics of the iron 
workers clambering up the steel construction of the new University 
Hospital. He would say, "All a same monkey-tee." 

Some days he summoned enough strength to make a few arrows, 
or to talk of his life in the wilds, or discuss hunting, bow making, 
Indian methods of hunting, folklore, and kindred subjects. 

All this time he had a moderate cough ; but repeated examination 
failed to show tubercle bacilli. His abdomen became more sensitive, 
and he developed signs of pyloric obstruction. After taking food he 
apparently experienced great pain. Even water caused him misery 
and I have seen him writhe in agony, with tears limning down his 
cheeks, yet utter no sound of complaint. At this period, when he 
seemed to be failing so rapidly that the end must be near, I coaxed 
him to get out of bed and let me take his picture once more. He was 
always happy to be photographed, and accommodated me. It was 
only after the picture was developed that I recognized to what a 
pitiful condition he had been reduced. Had this been apparent before, 
I should not have asked this exertion of him. 

This was his last picture, and compared with his varjdng poses, 
it records a tragic tale. We see him first as the gaunt, hunted wild 
man, his hair burnt short, his body lean and sinewy, but his legs strong 



206 Univcr^it}/ of CaUfontUi Publications in Am. Arch, and Ethn. [Vol. 13 

and capable of great eiiduranee. He suggests the coyote in this 
character. 

Later, civilization agrees witli lum. lie loses his hunted look, rounds 
out his shrunken frame, and is liap})y in his new-found friends. Then 
comes a period of over-feeding, the luxury of food which he himself 
decides is not best for him. 

In 1914 we see him at his best. On the trip to Tehama County he 
was undoubtedly in prime health. His stature is magnificent. 
Although he has lost the typical Indian litheness, there is grace and 
strength in every contoui'. For a year he was absolutelj^ perfect. He 
worked, hunted, plaj-ed, and enjoyed life. 

Then a gradual change overcame him. His energy waned. He 
no longer was keen to shoot at targets with the bow. His skin became 
dai-ker. He contracted anolhei' cold. He lost weight and wanted to 
rest most of the time. There were periods of slight improvement and 
we had hope that a return to his primitive mode of life might benefit 
him. 

But as his malady increased, his cougli became more distressing, 
fever consumed him, and eating became impossible. Our city water 
did not taste good to him, and he asked me to get him fresh spring 
water — "sweet water" he called it. We made a special effort to do 
this for him. 

Although starving, racked with hiccough or coughing, and in more 
or less constant distress, he never complained. He never spoke of 
his suffering; never referred to death. 

In March, 1916, when his weakness progressed to an extreme 
degree, we moved him back to the hospital where he could receive 
better nursing and alinu'utary feeding. 

Shortly after re-entering the hospital he had a very large pul- 
monary' hemorrhage. This was the first complication of this sort he 
experienced. I was called to his side. He was very weak and faint. 
With stoic calmness he looked at the quantities of blood that poured 
from his mouth and nose. 1 administered a large dose of morphia. 
He died soon after, at 12:20 p.m., March 25, 1916. 

The clinical record of his last admission is as follows: 

Ishi.—No. 11032. March 18, 1916. Well developed but extremely emaciated, 
dark skinned Indian lying in bed and hiccoughing frequently; vomiting and 
retching occasionally, evidently in great distress. 

Facies shows broad prominently arched nose; high malar bones and sunken 
cheeks; orbital depressions deep, apparently from wasting. 



1920] 



Pope: The Medical History of Ishi 



207 



Hair on scalp reaches to below shoulders, is thick, straight, and black with 
only a few gray hairs over the temples; eyebrows are dark and heavy; whiskers 
are thin and mostly gray ; axillary and pubie hair normal ; body hair scant. 

Skin is in good condition and everywhere deeply pigmented (racial). Sub- 
cutaneous tissues gi-eatly diminished. 

Eyes.— Vn-pils equal, circular; react to light and distance. There is moderate 
arcus senilus. Sclerae are dirty white and vessels somewhat congested. Con- 
junctiva pale. Muscles negative. Fundi not examined. 



Dullness flat 
diminished 
breathing. 
Many 
bubbling 
rales. 




th occasional 

high_pitched 
expiration rales. 



Nose. — Broad, high arched, with prominent alae nasae; mucous membrane 
pale; some discharge of thin mucous type. 

Mouth. — Teeth are all present and slightly dirty but well preserved. Gums 
are dark and in very good condition. Tongue protrudes in midline, is clean; no 
tremor. Throat show^s much saliva and debris from continual expectoration and 
vomiting. Tonsils negative. 

Glands. — There is no marked superficial lymph adenopathy; epitrochlears or 
supra-clavicular not felt; thyroid negative. 

Chest. — Emaciated with retracted supra and infra clavicular space; ribs, 
clavicles, and vertebrae easily seen and palpable; subcutaneous tissues and 



208 Universiti/ of California Publieations in Am. Arch, and Ethn. [Vol. 13 

nuisdes are ^roatly (liiiiinished ; angles of scapulae stand out. Right c'liest moves 
slightly better than left. 

Lungs. — As a whole, right chest shows better resonance than left, more rfiles 
and poorer quality of breathing on left, especially at left base below lOth dorsal 
vertebra. No Grocco sign can be made out. 

Heart. — Apex unpulse seen and felt in 5th space 10 cm. to left of midline 
(.f) cm. outside nipple line). Dullness from midline 11 cm. to left in .5th space; 
behind sternum to right. Sounds are rapid, of fair quality, with reduplication of 
tiio aortic and pulmonary sounds. No murmurs heard. 

Pulse. — Radials are of poor volume, equal; walls are soft. Carotids, riglit 
larger than left. Dorsalis pedis palpable. 

Abdomen is slightly .scafoid and shows few spots of hyper-pigmentation. No 
visible peristalsis. Wall is rather tense, but no masses can be felt; liver is 
palpable 3 cm. below ribs and at right edge of rectus disappears beneath stiff 
muscle. 

Spleen and kidneys not felt. No fluid. 

Genitals. — Negative. Prostate negative. No abnornuil masses felt. 

Hack. — Normal as far as can be ascertained. Thorougli examination almost 
impossible [on account of weakness of patient] . 

Extremities. — Very greatly emaciated. Skin over feet is very dry. 

Beflexes. — Patella and Achilles present and equal; Achilles very sluggish; no 
knee or ankle clonus; no Keruig or Oppenheim; plantar reflex normal. Abdom- 
inals and cremasterics present and normal. Wrist, biceps, triceps normal. Jaw 
jerk normal. No Chvostek or Trousseau signs. 

• Afar. ^1, 1916. — Patient has coughed considerable and hiccough has been 
very annoying. He refuses all food and when coaxed to take small amount of 
nourishment, he vomits soon after. Attempt to pass stomach tube was unsuc- 
cessful. Tube appeared to meet with an obstruction about 2 inches above cardia. 
Patient was greatly irritated and attempt was not continued. 

I)uriii«; thi.s la.st wwk. tlic fever raiiord between 37 C and 39.8 C. 
His pulse rate varied from cSf) to 130 per minute, the respiration from 
24 to 35. Other data are: 

lilood 6'ow?it.— Red cells, 4,9.50,000. White cells, 11,200. Hemoglobin, 73%. 
Differential count: Neutrophiles, G0%. Eosinophiles, 1%. Basophiles, 0. Small 
lymphocyU's, 30%. Large lymphocytes, 9%. 

f/n«a/.i/,s-is.— Specific gravity, 1022. Reaction, acid. No albumen, no sugar. 
Bile pigment, acetone, and diacetic acid i)reseut. No pus. Few cylindroids 
present. 

Treatment. — "Muri)hy drij)" (salt solution per rectum), magnesium oxide, 
bismuth subnitrate, hot apj)lications to the abdomen, morphine sulphate for pain. 

Sputum Examin.ation. — Watery, purulent clumps, streaked with blood. Bacillus 
tuberculosis in great number. 

Irvin H. Betts, Interne. 

Mar. 24, 1916. — Patient vomit^-d about 400 cu. em. of bloody material. Blood 
was frothy and partially dark and partially bright red in color. He has been 
receiving nourishment by Murphy drip (normal salt solution and 5%- glucose, 
through colon tube.) 

Mar. 25, 1916. — Again vomited about 250 cu. cm. bloody material. Given 
morphine suiphatt^ gr. M>, hypoderniically. At 12 noon he had a very severe 



% 

1920] Pope: The Medical History of Ishi 209 

hemorrhage, blood goishing from nose and mouth. The patient died inmiediately. 
Discharged. Diagnosis, pulmonary tuberculosis. Condition, dead. 

Discussion of case before autopsy. — Diagnosis: Advanced pulmonary tuber- 
culosis, disseminated most at left apex. Hemoptysis. Fibrous tuberculous pleurisy, 
more at left base. 

E. H. Falconer, Eesident Physician, 



POST MORTEM EXAMINATION 

The autopsy was performed a few hours after the death of Ishi 
by Dr. J. V. Cooke. The report in full is as follows: 

Post Mortem Eecord of the Pathological Laboratory of the University of 

California Hospital 

Ishi. Hospital Number 11032. March 25, 1916. 

The body is that of a considerably emaciated Indian 168 cm. in length. 
There is no rigor mortis. The body is still warm. The pupils are of moderate 
size and equal. No discharge from the ears. Slight bloody discharge from the 
nose and mouth. The thorax is large and emphysematous. The abdomen is of 
moderate size. The genitalia show some increase in brown pigmentation. Both 
testes are in the scrotum. The legs show a considerable emaciation and no evi- 
dence of edema. 

Abdominal Cavity. — Tlie fat in the anterior thoracic and abdominal walls 
shows a considerable atrophy and increase in yellowish pigment. The peritoneal 
surfaces are smooth and free from acute exudate. There are a few scattered 
nodules which vary in size from 1 to 8 mm, and which, on section, show gray 
somewhat translucent tissue and some of the large ones show central caseation. 
The mesenteric lymph nodes show a very considerable enlargement and a number 
of these nodules are found in the omentum and attached to the peritoneal surface 
of the mesentery. On the surface of the stomach and intestines there are found 
fair numbers of small similar nodules which arc firm, gray, and many of them 
appear to be conglomerate masses. The lower portion of the right lobe of the 
liver shows a mass measuring 9X5X3 cm. wliieh lies in close contact and 
parallel to the lower border of the right lobe. This is semifluctiuint and on 
section shows firm, fibrous encapsulation with some softened caseous material in 
the center. The surface of the liver shows a number of adhesions and there is a 
large nodule about 3 cm. in diameter, which, on section is caseous, attached to 
the anterior surface of the liver near the lesser curvature and also to the left lobe 
of the liver. The lower portion of the small intestine is adherent to the caecum 
and there are adhesions between the spleen and diaphragm. The pelvis shows 
a moderate amount of localized peritoneal foci similar to those in the remainder 
of the peritoneum. The appendix is 5 cm. in length and negative. The dia- 
phragm reaches the fifth rib on either side. 

Thorax. — On removing the sternum, the left lung is found firmly bound to 
the chest wall by old fibrous adhesions. The right lung is pale, vohmiinous anter- 
iorly and shows some easily broken fibrous adhesions at the apex. The pericardium 
is smooth and the cavity contains about an ounce of clear yellowish fluid. The 
anterior mediastinal lymph nodes are enlarged and on section show some small 
areas of caseation with moderate hyperplasia. 



210 University of California Publications in Am. Arch, and Ethn. [Vol.13 

Heart. — Weiglis 210 j;^ranis and is noticeably small. The right auricle is 
small ami the auricular appendage free from thrombi. The foramen ovale is 
closed. The tricuspid valve is negative. The right ventricle is of moderate size 
and the pulmonic valve and artery smootlu The mitral valve is tliin and delicate. 
The chordae tendineae are not thickened. The aortic valves are negative. The 
arch of the aorta shows a few slight areas of yellowish thickening immediately 
above tlie valves and around the coronary arteries. For the most part, however, 
it is smooth and elastic. The coronary arteries are patulous and show a few small 
patches of sclerosis in their proximal portions. The myocardiiun is firm and 
shows a slight increase in bro^\Tiish pigmentation. 

Lungs. — Tlie right lung weighs 770 grams. It is large, voluminous, and 
cushiony. It is crepitant and firm areas are felt throughout iu the upper, middle, 
and lower lobes. The extreme apex shows a smooth, moderately contracted patch 
of pleural tliickening measuring about 3X4 cm. Section through this area shows 
a cavity the size of a small walnut immediately beneath the pleura. This cavity 
contains blood clot and some fluid blood. On removing this the wall is seen to be 
somewhat irregular, gray, an<l covered Avith slight grayish exudate. Extending 
do\\"n into the pulmonic tissue from this point there is a firm consolidation into 
which the cavity is beginning to burrow. Tliis cavity communicates with a 
moderate sized bronchus. A more anterior section shows numerous scattered, 
opaque yelloA\ish gray foci 2 to 4 mm. in diameter lying in gray fibrous tissue. 
In places there are seen small cavities .5 to 1 cm. in diameter. This condition 
persists throughout the upper lobe. 

The middle lobe shows numerous grayish small tubercles some of which are 
collected in firm masses about 1 cm. in diameter. The individual foci are gray 
and surrounded by a moderate amount of fibrous tissue. The lower lobe is riddled 
with foci of disseminated tuberculosis. The bronchi at the root contain blood 
clot which makes a cast of the larger bronchu The pulmonic artery is negative. 
The bronchial lymph nodes are small and show a moderate amount of coal pig- 
ment. On section there are some grayish irregular foci of tuberculosis^ The left 
lung is considerably smaller than the right and is very adherent to the chest 
wall. At the apex a portion of the lung had to be left attached tfl the parietal 
pleura. At the base and mesially the pleura showed a very marked fibrous thick- 
ening, being in places over 1 cm. iu thickness. The pleura on section is grayish 
and caseous, although it is not softened, resembling the firm caseation sometimes 
seen in adrenal tuberculosis. The lung crepitates and is rather firm in the lower 
lobe. On section there are seen some disseminated tubercles throughout. The 
upper lobe anteriorly shows the most advanced process in the lung. Here are 
found several small cavities and one cavity about the size of a walnut which 
contains greenish yellow muco-purulent material. The bronchi at the root con- 
tain blood clots. The pulmonic art«ry is negative. The broiudiial lymph nodes 
are considerably pigmented. On section they show gray tissue Avitli small localized 
£oei. 

Spleen. — "Weighs 140 grams and there are some fibrous adhesions ov(M- the 
capsule. The consistency is fairly firm. On section the pulp is reddish brown 
and smooth. The Malpighian bodies are distinct and do not appear numerous. 

Liver. — Weighs 1240 grams. Over the surface, particularly over the right 
lobe, there are some tuberculous foci measuring 2 to 5 mm. in diameter and 
attached to the capsule. In the broad ligament there is a large focus, which, on 
section, contains yellowish gray caseous material. Tliis area is 2 cm. in diameter. 
Numerous other areas are found in the region of the broad ligament but some- 
wiiat smaller than tlie one above mentioned. 



1920] Fope: The Medical History of Ishi 211 

GaU-hladder. — Is of moderate size and negative. The lymph nodes around the 
hiliim of the liver are moderately enlarged and on section show grayish opaque 
foci. On section the liver tissue is quite pale brown and the lobules appear 
regular. Occasionally there is an opaque grayish focus about .5 to 1 cm. in 
diameter scattered through the hepatic substance. 

Kidneys. — -Are similar and together weigh 270 gi-aras^ The capsule strips 
easily and leaves a surface on which the fetal lobulations are still distinct. The 
cortex is quite opaque gray and the markings are regular. The Malpighian 
bodies are seen as minute red points. Tlie pyramids, pelvis, and ureter are 
negative. 

Adrenals. — Tlie right adrenal is almost completely transformed into grayish, 
firm, caseous muscle. Only a small portion near the upper lobe shows the stinicture 
of the adrenal gland. The left adrenal shows near its middle portion a focus of 
tuberculosis about 1 em. in diameter, but most of the gland remains and shows 
milky medulla and a moderate amount of lipoids in the cortex. 

Urinary bladder. — Shows a pale mucosa and is negative. 

Prostate gland. — Is not enlarged and on section is laegative. 

Alimentary canal. — Tlie stomach is of moderate size and contains a consider- 
able amount of clotted blood — altogether a pint. There is no obstruction to the 
outflow of the stomach. The duodenum contains a moderate amount of bile- 
stained fluid. 

Pancreas. — Is soft and glandular on section. There is no gross evidence of 
increase in interstitial tissue. 

Intestines. — The small intestine shows tjiaical tuberculous ulcers which are 
more marked in the lower ileum. These are quite iiTegular and show excavated 
edges. These ulcers are found in the upper jejunum. The first one seen is 
about 50 cm. below the duodenum, is irregular in outline and measures about 
2X3 cm. in size. The edges are raised and more or less irregular. The peri- 
toneal surface at this point is riddled with small foci of tuberculosis which extend 
girdle-wise around the gut. Two or more ulcers are found one foot loAver in the 
intestine, and as one passes down into the lower portion of the jejunum and into 
the ileum these ulcerations become slightly more numerous although it is unusual 
to find more than an average of one every foot. 

In the lower portion of the ileum there are found in the Peyer 's patches 5 or 
6 small areas of ulceration about 3 cm. in diameter -with thick grayish raised edges 
in which can be seen minute tubercles. Between these patches can be seen some 
small tubercles which have not yet broken down. In the lower ileum the mucosa 
shows a very marked irregular ulceration. There is a patch about 4 cm. in length 
Avhich shows practically no normal mucosa but large serpiginous ulceration. Here 
the wall is very much thickened and the lymph nodes immediately beneath the 
intestines are large, matted together, and caseous. They measure from 1 to 3 
cm. in diameter. The large intestine is free from ulceration. The process appar- 
ently stops abruptly at the ileocaecal valve. 

The peritoneal surface of the intestines, particularly the small intestine, shows 
a considerable number of single and conglomerate tubercles around the foci of 
ulceration in the mucosa. There are, however, other foci of tuberculosis which 
are composed of small nodules varying from .3 to 2 cm. in diameter Avhich are 
attached to the serosa by a thin layer of fibrous tissue and Avhieh are definitely 
pedunculated. These masses attached to the peritoneum are a rather marked 
feature of the peritoneal tuberculosis. 

Mesenteric lymph nodes. — Are all considerably enlarged, some of them reaching 
2 to 3 cm. in size. On section they show irregular grayish areas of caseation 
between which there is a translucent grayish tissue. 



212 University of Californiu Publications in Am. Arch, and Ethn. [Vol. 13 

Aorta, from arcli to bifurcation, is quite elastic, and is of nioilerate size. 
There are some patclies of subintimal fatty degeneration but apparently no 
evidence of arterial degenerative changes. 

Brain. — Weighs 1300 grams. It is removed and shows no gross abnormalities 
with the exception of some increase in fat beneath the pia. The skull is small 
and rather thick. 

Microscopic Exam ination 

Heart. — The muscle fibers arc small. There is no increase in fibrous inter- 
stitial tissue. 

Lung. — One section shows numerous scattered small areas of tuberculosis, 
some of which are single and others conglomerate. These are central areas of 
caseation surrounded by giant cells, epithelioid cells, and lymphoid cells. Around 
some of these areas there is an exudate in the alveoli composed of leucocytes, 
lymphoid cells, and fibrin. In some places this exudate is caseous. Another sec- 
tion shows a large patch of caseous pulmonary exudate in which the walls of the 
alveoli are also involved in the necrosis. Around this area there is desquamative 
pneumonia and scattered tubercles. Another section shows a similar picture to 
the one described. 

Mediastinal lymph nodes. — Tliere is a nuxlcrate ])ignientation by carbon and 
numerous scattered epithelioid tubercles, some of wliicli show a central caseation. 
Giant cells are found in fair numbers. 

Spleen. — The Malpighian bodies are small. Many portions of the pulp show 
a considerable amount of brownish pigmentation. This pigment is present in 
large phagocytic cells. Several small caseous tubercles are found which are 
atypical. The pulp is not congested. 

Liver. — There are scattered small tubercles throughout the liver parenchyma, 
and moderate fatty change at the periphery of the lobules. Section shows one 
rather large area of caseation surrounded by epithelioid and lymphoid cells. 

Kidney. — The convoluted tubules are irregular, sAvollen, and granular. No 
areas of tuberculosis are found and the interstitial tissue is not increased in 
amount. 

Adrenals. — One section shoAvs normal appearing adrenal gland except for a 
rather large caseous tubercle in the surrounding connective tissue. Another 
section shows almost complete displacement of the glandular tissue by necrosis. 
This area of necrosis is surrounded by epithelioid, lymphoid, and giant cells 
together with some fibrous tissue. 

Intestine. — Section of one of the ulcers in tlie ileum shows a typical tuber- 
culous process. The submucosa is infiltrated with large caseous tubercles and the 
mucosa has disappeared at one point lea\4ng a ragged ulcer. There are many 
tubercles beneath the serosa and a diffuse infiltration with epithelioid and 
lymphoid cells. 

Pancreas. — The acini and Islands of Langerlians are negative. There is no 
increase in interstitial tissue and no tubercles are found. 

Scalp. — Appears normal. 

Microscopic Dixignosis. — Miliary tubercles in lungs, spleen, and kidneys. Ulcer- 
ative tuberculous enteritis. Tuberculous peritonitis. Tuberculous broncho- 
pneumonia and gelatinous pneumonia. Tuberculosis of adrenals. Parenchymatous 
degeneration of liver and kidneys. 

Dr. Jean V. Cooke. 



1920] Pope: The Medical History of Ishi 213 



CONCLUSION 

It is my opinion, and also that of Dr. Karl F. Meyer, Professor of 
Bacteriology in the University of California, with whom I have dis- 
cussed the matter, that Ishi derived his infection through the intestinal 
route, and that he had the bovine type of tuberculosis. His was the 
genuine "pearl sickness," and he had relatively no acquired or 
hereditary immunity. Consequently his disease was rapidly fatal. 

His body was carried to the undertakers, where is was embalmed. 
No funeral services were held. Professor T. T. Watennan, Mr. E. W. 
Gilford, Mr. A. Warburton, Mr. L. L. Loud, of the Museum of 
Anthropology, and I visited the parlor, and reverently placed in his 
coffin his bow, a quiver full of arrows, ten pieces of dentalia or Indian 
money, some dried venison, some acorn meal, liis fire sticks, and a 
small quantity of tobacco. AVe then accompanied the body to Laurel 
Hill cemetery near San Francisco, where it was cremated. The ashes 
were placed in a small Indian pottery jar on the outside of which is 
inscribed: "Ishi, the last Yahi Indian, died March 25, 1916." 



UNIV. CALIF. PUBL. AMER. ARCH. &. ETHN. VOL. 13 [POPE] PLATE 38 




ISHI ON' HIS DISCOVERY IX 1911. 



^ 




a to 






< 

o 

w 


'*'■'«■ „*" '^ ^^^B 




\?', 9 












UNIV. CALIF, PUBL. AMER. ARCH. & ETHN. VOL. 13 [POPE] PLATE 42 



Fig. 1 



Fig. 2 



Fig. 3 




ISHI 'S FEET FROM LIFE AND CASTS 



UNIV. CALIF. PUBL. AMER. ARCH. & ETHN. VOL. 13 [ POPE 1 PLATE 43 



Fig. 1 



Fio-. 2 



Fia-. 




CASTS OF ISHI S FEET 



UNIV, CALIF. PUBL. AMER, ARCH. & ETHN. VOL. 13 [POPE] PLATE 44 




"^^ijprf^ 



DEATH MASK, JIARCH, 191(3 



H32 75 541 















x*^r^ 






^^•^-^, 



^^. 



.0- 
.0' 


















<^^ 









'-^-^ 



.0' 









/, 



-i- 






■^^ 






' '.V 'x. • 



A 



-1 O, 



^" •'; 






^. 



^^ 






•v "^ '.^ 



v\ 



A. 



^ 



*-. 






^' 









..-^ .v^v.'. V ^c>^ .V 



-;^., 



•^ .,<<. ' ^4^:^.r. '%^^ ^' ^^^-^ 






li 



■■%%'^- 












c 



^\ 



A. 



<*. 



■'''^- ,-^^\^J^^^ "'^'f> 



.^0^ 









.1-^ 



•^ .^^^ 



^..^^^ 






A 



.0 













7 ^^^ 
/ -y -^ 









<? 






aO' 



0' 



"K 

'^x. 






o " = * <* . 






■4 • s • * > ^^ 









A 






- ^^ ■ ^ 



Av>. 



<^^^'% ^^^V€^ '^^"'^ 






V' ^k\^' * a'^ 






o 






A 



<*. 






.<Jv" ° " ° . ^<^. O^" . ^ " -» '^O " -"^ 






0-^ 



A 



■^0' 

^^^ 



o^ "0.0" A 









^ '-r^^^> <L^^ <rv ^^■'%:^.^ ') 


















^. 



A^ "^, 



o_ j.'^ c°/A- -^^ A^ .• ^j 



^, 



=^0 ,^* .'^>.'^'t. C^ .^ 



•<:'^ - . . 5 * A 



V-^^ 
s^% 



■u 






^^ "'<*-. 



.^ 

'^^ 



0' ^^ 



% 









^:^ 












A 



""^ 



^ 






"<^, 



\s 






o 



oT:^' .0^ 



vj> 



,0^ 






o 



o S 






'^^ 



->o 



^0^ 



"-^^o^ 






*-^ 






,^^' % .0'^ *^^-..T,-'y 'O^ ^0' 



G -^ 

. ir O > 










C- 












o 




C^'" .' 






^. 



%■ 



















■a? -^ 



^^ 






